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Yr 4 - CCC > Corrections GI 3 > Flashcards

Corrections GI 3 Flashcards

1
Q

What 2 investigations are contraindicated in ulcerative colitis in the acute setting?

A

1) colonscopy
2) barium enema

due to risk of bowel perforation

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2
Q

What barium enema findings would you expect to see in ulcerative colitis?

A
  • lead-piping inflammation (2ary to loss of haustral markings)
  • thumb-printing (a marker of bowel wall inflammation)
  • pseudopolyps (due to areas of ulcerating mucosa adjacent to areas of regenerating mucosa)
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3
Q

Cause of pseudopolyps in UC?

A

Due to areas of ulcerating mucosa adjacent to areas of regenerating mucosa.

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4
Q

Cause of lead-pipe appearance on barium enema in UC?

A

2ary to loss of haustral markings

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5
Q

What is the first line medical treatment to maintain remission in Crohns?

A

Azathioprine or mercaptopurine

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6
Q

What neurological complications can be seen in coeliac disease? (3)

A

1) Loss of balance: ataxia, loss of coordination, falls

2) Sensory symptoms: numbness in glove and stocking distribution

3) Headaches

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7
Q

Cause of loss of balance in coeliac?

A

Gluten ataxia

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8
Q

Cause of sensory symptoms in coeliac?

A

Gluten neuropathy

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9
Q

Cause of headaches in coeliac?

A

Gluten encephalopathy

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10
Q

Management of gastroparesis (3)?

A

1) Diet e.g. low fibre, smaller/more frequent meals

2) 1st line: domperidone (dopamine receptor antagonist)

3) 2nd line: metoclopramide or erythromycin (motility agents)

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11
Q

What are the management options in a peri-anal abscess?

A

IV Abx, examination under anaesthetic with incision and drainage

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12
Q

What are the extra-intestinal signs of Crohn’s disease?

A

1) Erythema nodosum

2) Arthritis

3) Gallstones

4) Renal stones

5) Ocular: anterior uveitis & episcleritis

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13
Q

Which type of inflammatory bowel disease are non-caseating granulomas seen in?

A

Crohn’s

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14
Q

What is the initial medical management of a severe flare of ulcerative colitis?

A

Admit to hospital for IV steroids and rehydration

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15
Q

What is the cause of Gilbert syndrome?

A

Reduced activity of UDP glucuronosyltransferase (the hepatic enzyme responsible for conjugation of bilirubin) resulting in indirect hyperbilirubinemia.

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16
Q

Which alternative serological test can be performed if IgA anti-TTG is weakly positive in coeliac disease?

A

Anti EMA

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17
Q

hat is the inheritance pattern of haemochromatosis? (1)

What gene is affected? (1)

A

Autosomal recessive

Human haemachromatosis protein (HFE) gene

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18
Q

What medication is used for diarrhoea symptoms in irritable bowel syndrome? (1)

A

Loperamide

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19
Q

What is the usual screening test for Helicobacter pylori infection in the community? (1)

A

Stool antigen test

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20
Q

What medications are used to manage hepatic encephalopathy? (2)

A

1) Lactulose (aiming for 2-3 soft stools daily)
2) Abx, usually rifaximin

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21
Q

What scoring system is used to assess the severity of liver cirrhosis and the prognosis? (1)

A

Child Pugh score

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22
Q

What are the top genetic diseases that cause liver cirrhosis? (3)

A

Haemachromatosis
Wilson’s
A1AT deficiency

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23
Q

What is the inheritance pattern of alpha-1 antitrypsin deficiency? (1)

What gene is affected? (1)

A

Autosomal co-dominant

SERPINA1 gene coding for alpha-1 antitrypsin on chromosome 14

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24
Q

Which hepatitis B marker is used to screen for active infection? (1)

A

Surface antigen HBsAg

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25
Q

What specific enzyme is central to how alpha-1 antitrypsin deficiency affects the lungs? (1)

A

Neutrophil elastase

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26
Q

What investigation is used to assess the stiffness of the liver using high-frequency sound waves to determine the degree of fibrosis and cirrhosis? (1)

A

Transient elastography (“Fibroscan”)

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27
Q

What are the options for prophylaxis of bleeding in stable oesophageal varices? (2)

A

1) Propanolol
2) Variceal band ligation

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28
Q

What test for Helicobacter pylori can be performed during an endoscopy procedure? (1)

A

Rapid urease test (CLO test)

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29
Q

What treatment may be used to induce remission in Crohn’s disease where there are concerns about the side effects of drugs, particularly in children? (1)

A

Enteral feeding

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30
Q

What tool is used in alcohol withdrawal to score a patient on their symptoms and guide treatment? (1)

A

CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised) tool

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31
Q

What treatment for liver cancer involves injecting chemotherapy directly into the hepatic artery that feeds the tumour? (1)

A

Transarterial chemoembolisation (TACE)

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32
Q

What are the four most common causes of liver cirrhosis? (4)

A

1) Alcohol related liver disease
3) Non-alcoholic fatty liver (NAFLD)
3) Hep B
4) Hep C

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33
Q

Which type of viral hepatitis is a DNA virus, as opposed to the other types, which are RNA viruses? (1)

A

Hep B

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34
Q

What investigation is used to confirm the diagnosis of inflammatory bowel disease? (1)

A

Colonoscopy with multiple intestinal biopsies

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35
Q

What features indicate decompensated liver disease (as opposed to compensated)? (4)

A

1) Ascites
2) Bleeding oesophageal varices
3) Jaundice
4) Hepatic encephalopathy

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36
Q

What treatment causes vasoconstriction and slows bleeding in patients with bleeding oesophageal varices? (1)

What other medical treatment is routinely given with bleeding varices and why? (2)

A

Terlipressin

Prophylactic Abx: shown to reduce mortality

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37
Q

What is the first-line treatment for maintaining remission in ulcerative colitis? (1)

A

Topical +/- oral 5-ASAs e.g. mesalazine

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38
Q

What condition causes a drop in haemoglobin and a rise in bilirubin? (1)

Why does bilirubin rise in this situation? (1)

A

Haemolytic anaemia

Bilirubin released with RBCs rupture

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39
Q

What blood test is the first-line investigation for assessing fibrosis in non-alcoholic fatty liver disease? (1)

A

Enhanced liver fibrosis (ELF)

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40
Q

What key risk factors for peptic ulcers involve disruption of the mucus barrier? (2)

A

H. pylori infection
NSAIDs

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41
Q

What is the tumour marker for cholangiocarcinoma? (1)

A

Ca19-9

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42
Q

What liver enzyme is particularly raised in primary sclerosing cholangitis? (1)

A

ALP

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43
Q

What two skin signs may be seen on examination of a patient with primary biliary cholangitis, and what is the underlying cause of these changes? (2)

A

1) Xanthelasma (cholesterol deposists in skin) –> caused by high serum cholesterol

2) Jaundice –> caused by high serum bilirubin

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44
Q

Which two types of receptor does alcohol act on in the brain, and what effect does it have on those receptors? (2)

A

1) Stimulates GABA

2) Inhibits glutamate receptors (NMDA receptors)_

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45
Q

What time period after stopping drinking does delirium tremens start? (1)

A

24-72 hours

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46
Q

What effect does alcohol have on the mean corpuscular volume (MCV)? (1)

A

Raised

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47
Q

What scoring system is used after endoscopy to estimate the risk of rebleeding and mortality in upper GI bleeding? (1)

A

Rockall

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48
Q

Patients with which condition are screened every six months for liver cancer? (1)

What does screening involve? (2)

A

Liver cirrhosis

Liver US & alpha fetoprotein

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49
Q

What type of organism is Helicobacter pylori? (3)

A

Gram negative aerobic

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50
Q

What interventional radiology procedure may be used as secondary prevention of bleeding oesophageal varices? (1)

What is the other major indication for this procedure? (1)

A

Transjugular portosystemic shunt (TIPS)

Refractory ascites

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51
Q

What stool test is used to screen for inflammatory bowel disease? (1)

A

Faecal calprotectin

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52
Q

What blood test is considered in women (but not men) when excluding other causes of the symptoms of irritable bowel syndrome? (1)

What does this screen for? (1)

A

Ca125

Ovarian cancer

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53
Q

What surgical procedure may be used to treat ulcerative colitis definitively? (1)

A

Panproctocolectomy (removing the entire large bowel and rectum)

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54
Q

What is an alternative for maintaining remission in Crohn’s where 1st line options are not suitable?

A

Methotrexate

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55
Q

Is episcleritis more common in Crohn’s or UC?

A

Crohn’s

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56
Q

Is uveitis more common in Crohn’s or UC?

A

UC

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57
Q

Where is abdo pain typically prevalent in UC?

A

LLQ

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58
Q

1st line medications in IBS?

a) for constipation
b) for diarrhoea
c) for cramps

A

a) bulk forming laxatives e.g. ispaghula husk

b) loperamide

c) antispasmodics e.g. mebeverine, hyosine butylbromide

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59
Q

What laxative is AVOIDED in IBS?

A

Lactulose (can cause bloating)

60
Q

What is mebeverine?

A

An antispasmodic used in the symptomatic treatment of stomach pain and spasms associated with IBS.

61
Q

Other treatment options in IBS where symptoms remain uncontrolled? (3)

A

1) Low dose TCAs

2) SSRIs

3) CBT

62
Q

Coeliac disease is associated with what 2 human leukocyte antigen (HLA) genotypes?

A

1) HLA-DQ2 (95%)
2) HLA-DQ8 (80%)

63
Q

Rarely coeliac disease can present with neurological symptoms.

What are some of these symptoms? (3)

A

1) Sensory disturbance (peripheral neuropathy)

2) Ataxia

3) Epilepsy

64
Q

How can coeliac lead to anaemia?

A

Anaemia occurs secondary to malabsorption and deficiency of iron, B12 or folate.

65
Q

What is a key dermatological manifestation of coeliac?

A

Dermatitis herpetiformis

66
Q

How to test for coeliac in patients with IgA deficiency?

A

Test the IgG version of anti-TTG or anti-EMA

67
Q

Next investigations in patients with a positive Ab test in coeliac?

A

Confirmed via endoscopy and jejunal biopsy.

68
Q

Gold standard for coeliac diagnosis?

A

Endoscopy intestinal biopsy

69
Q

2 key biopsy findings that support coeliac disease?

A

1) Villous atrophy
2) Crypt hyperplasia

70
Q

How can coeliac disease cause hyposplenism?

A

Thought to be due to excessive loss of lymphocytes through the inflamed enteric mucosa.

71
Q

Is folate deficiency or vitamin B12 deficiency more common in coeliac?

A

Folate

72
Q

During the first stages of treatment, goserelin may cause a transient increase in symptoms of prostatic cancer.

What can be given alongisde?

A

Anti-androgen e.g. flumatide

73
Q

1st line management of patients with symptomatic perianal fistulae?

A

Oral metronidazole

74
Q

Management of a perianal abscess?

A

Incision + drainage + Abx therapy

75
Q

What drugs should be avoided in hepatic encephalopathy?

A

1) benzos
2) opiates
3) antidepressants
4) antipsychotics

76
Q

Which IBD is ‘cobblestone mucosa’ seen in?

A

Crohn’s - due to ulceration and mural oedema

77
Q

What should be checked before starting Azathioprine or Mercaptopurine?

Why

A

Assess for thiopurine methyltransferase (TPMT) activity before offering azathioprine or mercaptopurine.

The enzyme TPMT provides a major catabolic pathway for these drugs. In the absence of TPMT activity there will be an over-dose effect, resulting in complete bone marrow supression.

78
Q

What does a transjugular intrahepatic portosystemic shunt procedure (TIPS) connect?

A

The hepatic vein and the portal vein

79
Q

How long before an upper GI endoscopy should PPIs be stopped?

A

2 weeks

80
Q

What is the recommended treatment option for patients with Barrett’s oesophagus and high grade dysplasia?

A

Endoscopic mucosal therapy e.g. radiofrequency ablation (RFA) or endoscopic resection (ER).

This is ecause high-grade dysplasia is considered a precursor to oesophageal adenocarcinoma.

81
Q

Which cancer are patients with coeliac more at risk of developing?

A

enteropathy-associated T-cell lymphoma of small intestine

82
Q

Which medications should be withheld in a C. diff infection?

A

Medications which are anti-motility and anti-peristaltic e.g. opioids.

If possible, antibiotics should also be held to allow normal intestine flora to be re-established, though the antibiotics used to treat the Clostridium difficile should be continued.

83
Q

Why should opioids be discontinued in C. diff infection?

A

Can predispose to toxic megacolon

84
Q

What is the treatment of chioce for small bowel bacterial overgrowth syndrome?

A

Rifaximin

85
Q

Why is rifaximin good for small bowel bacterial overgrowth syndrome?

A

Rifaximin is poorly absorbed via the GI therefore allowing a large dose of antibiotic to reach its intra-luminal target without systemically high concentrations.

86
Q

1st line Abx for perianal fistula in Crohn’s?

A

Oral metronidazole

87
Q

What are some early signs of haemachromatosis?

A

Fatigue, ED and arthralgia

88
Q

What medication is indicated in ongoing diarrhoea in Crohn’s patient post-resection with normal CRP?

A

Cholestyramine

Diarrhoea is most likely due to bile acid malabsorption as a complication of the resection.

89
Q

What is cholestyramine?

A

A bile acid sequestrant with the potential to control diarrhoea induced by bile acid malabsorption.

90
Q

How are liver abscesses generally managed?

A

With a combination of Abx & drainage

91
Q

What are the grades of hepatic encephalopathy?

A

Grade I: Irritability

Grade II: Confusion, inappropriate behaviour

Grade III: Incoherent, restless

Grade IV: Coma

92
Q

What is the investigation of choice in PSC?

A

ERCP/MRCP

93
Q

Before starting ursodeoxycholic acid for primary biliary cholangitis, what investigation is required?

A

MRCP to exclude extrahepatic biliary obstruction, such as that caused by malignancies, before confirming the diagnosis.

94
Q

How can a diagnosis of small bowel bacterial overgrowth syndrome be made?

A

Hydrogen breath test

95
Q

What investigation may be useful for diagnosing and monitoring the severity of liver cirrhosis?

A

Transient elastography

96
Q

Management of all patients with a suspected upper GI bleed?

A

Endoscopy within 24 hours

97
Q

Which antibiotic is most closely associated with the development of C. difficile?

A

Clindamycin

98
Q

What sign can be seen on barium swallow in patients with oesophageal cancer?

A

‘Apple core sign’ - anatomical narrowing of oesophagus.

99
Q

Which area is most likely area to be affected by ischaemic colitis?

A

Splenic flexure - ‘watershed area’

100
Q

What does a positive HBsAg result imply?

A

Acute or chronic hepatitis B

101
Q

What does a positive anti-HBs result imply?

A

Immunity either through previous immunisation or disease.

102
Q

What is the investigation of choice in a suspected pharyngeal pouch?

A

Barium swallow combined with dynamic video fluoroscopy

103
Q

What condition associated with inflammatory bowel disease involves rapidly enlarging, painful skin ulcers, often on the legs? (1)

A

Pyoderma gangrenosum

104
Q

What proportion of newly infected patients with hepatitis C will develop chronic hepatitis C? (1)

A

75%

105
Q

What marker on a blood test is often the first indication of non-alcoholic fatty liver disease? (1)

A

Raised ALT

106
Q

What procedure can be used to treat dominant strictures in primary sclerosing cholangitis? (1)

A

ERCP

107
Q

What scoring systems are available to estimate the degree of liver fibrosis in patients with non-alcoholic fatty liver disease? (2)

A

1) NAFD Fibrosis Score (NFS)

2) Fibrosis 4 (FIB-4) score

108
Q

What scoring system gives an estimated 3-month mortality as a percentage for patients with liver cirrhosis? (1)

A

MELD (model for end stage liver disease) score

109
Q

What is the diagnostic imaging investigation for primary sclerosing cholangitis? (1)

A

MRCP

110
Q

What is the pathophysiology behind how certain genotypes of alpha-1 antitrypsin deficiency affect the liver? (1)

A

The liver produces an abnormal mutant version of the A1AT protein, which builds up in the liver cells and has a toxic effect, causing inflammation.

111
Q

Which type of viral hepatitis is only found in patients that also have hepatitis B? (1)

A

Hep D

112
Q

How is hepatitis A transmitted? (1)

A

Faeco-oral route

113
Q

What are the top autoimmune causes of liver cirrhosis? (3)

A

1) Autoimmune hepatitis

2) PSC

3) PBC

114
Q

What organisms most commonly cause spontaneous bacterial peritonitis? (2)

A

1) E. coli
2) Klebsiella pneumoniae

115
Q

What antibodies are most specific to primary biliary cholangitis and form part of the diagnostic criteria? (1)

A

AMA

116
Q

Which type of viral hepatitis can be cured with direct-acting antivirals? (1)

A

Hep C

117
Q

What 2 copper chelating agents are used in Wilson’s?

A

1) penicillamine

2) trientine

118
Q

What large vessels drain into the portal vein before it enters the liver? (2)

A

1) Superior mesenteric vein

2) Splenic vein

119
Q

What are the three stages of progression in alcohol-related liver disease? (3)

A

1) Alcoholic fatty liver

2) Alcoholic hepatitis

3) Cirrhosis

120
Q

What surgical option is available for severe gastro-oesophageal reflux disease? (1)

A

Laparoscopic fundoplication

121
Q

What is the main medical treatment for primary biliary cholangitis? (1)

A

Ursodeoxycholic acid

122
Q

What gene is implicated in haemochromatosis?

A

HFE gene

123
Q

What is the normal function of alpha-1 antitrypsin? (1)

A

Protease inhibitor

124
Q

What regular monitoring for complications is carried out in patients with liver cirrhosis? (3)

A

1) MELD score every 6 months

2) AFP & US every 6 months

3) Endoscopy every 3 years for oeseophageal varices

125
Q

Purpose of MELD score?

A

Gives an estimated 3-month mortality as a percentage for patients with liver cirrhosis

126
Q

What is seen on a liver biopsy in alpha-1 antitrypsin deficiency? (1)

A

Periodic acid-Schiff positive staining globules in hepatocytes

127
Q

When would a patient with ascites be given prophylactic antibiotics against spontaneous bacterial peritonitis? (1)

A

When there is <15 g/litre of protein in the ascitic fluid

128
Q

Why does low protein in ascitic fluid predispose to spontaneous bacterial peritonitis?

A

It is thought that the antibacterial activity of ascitic fluid is closely correlated with the protein concentration. Thus, patients with low protein levels are at higher risk for SBP.

129
Q

What is the inheritance pattern of Wilson’s disease? (1)

What gene is affected? (1)

A

Autosomal recessive

Wilson disease protein gene on chromosome 13 (ATP7B copper-binding protein)

130
Q

Which hepatitis B marker indicates active viral replication and high infectivity? (1)

A

E antigen (HBeAg)

131
Q

What condition involves duodenal or pancreatic tumour secretes excessive quantities of gastrin, resulting in excessive acid production in the stomach? (1)

What genetic condition is associated with developing gastrin-secreting tumours? (1)

A

Zollinger Ellison syndrome

MEN type 1

132
Q

What disease is associated with anti-smooth muscle antibodies (anti-SMA)? (1)

A

Type 1 autoimmune hepatitis

133
Q

What is the initial screening test for suspected Wilson’s disease? (1)

What result suggests Wilson’s disease? (1)

A

Serum caeruloplasmin

Low

134
Q

What is giardiasis?

A

Caused by the flagellate protozoan Giardia lamblia.

135
Q

How is giardiasis spread?

A

Faeco-oral route

136
Q

Symptoms of giardiasis?

A
  • often asymptomatic
  • lethargy, bloating, abdominal pain
  • flatulence
  • non-bloody diarrhoea
  • chronic diarrhoea, malabsorption and lactose intolerance can occur
137
Q

Management of giardiasis?

A

Metronidazole

138
Q

1st line investigation in giardiasis?

A

Stool microscopy

139
Q

At what INR is it only recommended to carry out a liver biopsy?

A

INR <1.5

140
Q

What type of laxative is macrogol?

A

Osmotic laxative

141
Q

What type of laxative is docusate sodium?

A

Both stimulant and softening mechanisms of action

142
Q

What is the most useful test for confirming the likely diagnosis of Primary Biliary Cholangitis?

A

AMA levels

143
Q

What is usually the 1st line medication for gastroparesis?

A

Metoclopramide

144
Q

What is the gold standard treatment for chronic hepatitis C?

A

Direct-acting antiviral (DAA) therapy e.g. sofosbuvir, ledipasvir and velpatasvir

145
Q

What organism is associated with gastroenteritis caused by consumption of unpasteurised milk, unrefrigerated meat and dairy products in non-immunocompromised people?

A

Staph. aureus (staphylococcal enteritis)

146
Q
A

Yr 4 - CCC (54 decks)

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